Antiplatelet Medications Overview

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Questions and Answers

Which medication is commonly used for the prevention of thromboembolic stroke?

Heparin

Abciximab

Aspirin

Clopidogrel (correct)

What is the mechanism of action of aspirin?

Inhibits the synthesis of both thromboxane and prostacyclin

Inhibits the synthesis of prostacyclin

Activates the plasma membrane to produce thrombin

Inhibits the synthesis of thromboxane (correct)

Which of the following antiplatelet medications are indicated for the treatment of acute coronary syndrome (ACS)?

Aspirin and Clopidogrel

Abciximab and Ticagrelor

Eptifibatide, Tirofiban and Clopidogrel

All of the above (correct)

What is the main difference between the mechanism of action of glycoprotein IIb/IIIa inhibitors and P2Y12 inhibitors?

Glycoprotein IIb/IIIa inhibitors block the binding of fibrinogen to platelet receptors, while P2Y12 inhibitors inhibit platelet activation. (C) Signup and view all the answers

Which medication is indicated for the prevention of heart failure?

Heparin (D) Signup and view all the answers

Which of the following medications is a reversible inhibitor?

Abciximab (C) Signup and view all the answers

Which of the following medications is administered orally?

Clopidogrel (C) Signup and view all the answers

Which medication is indicated for the treatment of acute ischemic stroke?

Aspirin (D) Signup and view all the answers

What is a common side effect of all antiplatelet medications?

Gastrointestinal bleeding (D) Signup and view all the answers

Which medication is commonly used in patients with active bleeding?

None of the above (D) Signup and view all the answers

Which of the following medication combinations is commonly used as dual antiplatelet therapy (DAPT)?

Aspirin and Clopidogrel (C) Signup and view all the answers

Which medication has a short acting effect and is typically administered IV or SQ?

Heparin (D) Signup and view all the answers

What is the main difference between antiplatelet medications and anticoagulants?

Antiplatelet medications prevent platelet aggregation, while anticoagulants prevent blood clotting. (D) Signup and view all the answers

What could be a contraindication for using Aspirin?

All of the above (D) Signup and view all the answers

What are potential side effects of Heparin?

All of the above (D) Signup and view all the answers

What is the primary action of Isosorbide mononitrate in the management of acute ischemic syndromes?

Decrease vascular pressure (C) Signup and view all the answers

Which of the following describes a potential effect of long-acting nitrates like Isosorbide in chronic coronary artery disease (CAD)?

Prevent chest discomfort (B) Signup and view all the answers

What is a common cautioned condition when using beta-blockers?

Chronic obstructive pulmonary disease (COPD) (D) Signup and view all the answers

How do beta-blockers affect heart function in patients with heart failure?

Decrease oxygen demand (B) Signup and view all the answers

Which situation may exacerbate with the use of beta-blockers according to their mechanism of action?

Asthma exacerbations (A) Signup and view all the answers

What is a notable potential side effect of non-selective beta blockers?

Bronchospasm (B) Signup and view all the answers

In which patient population should beta-blockers be used with caution due to the risk of metabolic changes?

Hypoglycemic patients on insulin therapy (A) Signup and view all the answers

What therapeutic effect do selective beta-1 antagonists primarily provide?

Reduced heart rate (D) Signup and view all the answers

What is the primary physiological impact of Isosorbide mononitrate in acute treatment?

Vasodilation (C) Signup and view all the answers

Which statement about beta-blockers and exercise is correct?

They can cause fatigue during exercise. (B) Signup and view all the answers

Study Notes

Antiplatelets

Aspirin (ASA): Inhibits cyclooxygenase, reducing platelet aggregation. Indications include acute coronary syndrome (ACS), myocardial infarction (MI) prophylaxis, and transient ischemic attack (TIA). Contraindications include aspirin or non-steroidal anti-inflammatory drug (NSAID)-induced asthma, and gastrointestinal (GI) bleeding. Side effects include bleeding, abdominal bleeding/ulcers, and bronchospasm. Aspirin is given orally (PO) and rectally (PR).
Glycoprotein IIb/IIIa inhibitors: Reversibly inhibit the binding of fibrinogen and von Willebrand factor to GPIIb/IIIa receptors, impairing hemostatic plug formation. Indications include high-risk patients with acute coronary syndrome (ACS) and urgent cardiac surgery. Contraindicated in active bleeding. Side effects include bleeding and thrombocytopenia. Administered intravenously (IV). Rarely used due to availability of dual antiplatelet therapy (DAPT) and P2Y12 meds.
P2Y12 inhibitors: Bind to P2Y12 adenosine diphosphate receptors, reducing platelet activation and aggregation. Indications include acute coronary syndrome (ACS), coronary artery disease (CAD) and prevention of thromboembolic events, including acute ischemic stroke (TIA). Contraindicated in active or intracranial bleeding. Side effects include bleeding, intracranial hemorrhage and dyspnea. Administered orally.

Anticoagulants

Heparin/Unfractionated Heparin (UFH): Activates antithrombin III, stopping prothrombin and preventing fibrinogen-to-fibrin conversion. Indications include prevention and treatment of deep vein thrombosis (DVT)/pulmonary embolism (PE). Contraindicated in active bleeding, and should be used with caution in patients with spinal or epidural injections. Side effects include bleeding and heparin induced thrombocytopenia (HIT). Administered intravenously (IV) or subcutaneously (SQ).
Low molecular weight heparin (LMWH): Inhibits thrombin and factor Xa. Prevention and treatment of DVT/PE, and risk reduction in atrial fibrillation. Contraindicated in active bleeding, and should be used with caution in patients with spinal or epidural injections. Side effects include bleeding and HIT. Generally given subcutaneously (SQ).
Fondaparinux: Selectively inhibits factor Xa. Indications include prevention/treatment of DVT/PE. Contraindicated in active bleeding and renal impairment. Side effects include bleeding. Administered subcutaneously (SQ).
Warfarin (Coumadin): Inhibits vitamin K-dependent coagulation factors. Indications include prevention and treatment of DVT/PE, prevention of stroke in patients with cardiac valve replacement, risk reduction in atrial fibrillation. Contraindicated in pregnancy (except in mechanical valve situations) and active bleeding. Side effects include bleeding, abdominal pain, alopecia, and tissue necrosis. Administered orally.

Direct Oral Anticoagulants (DOACs)

Apixaban, Rivaroxaban: Inhibits factor Xa and reduces thrombin generation and thrombus formation. Prevention/treatment of DVT/PE, atrial fibrillation (especially after joint surgery), and coronary interventions. Contraindications include active bleeding and major bleeding risk. Caution in patients with spinal or epidural catheters. Side effects include bleeding, abdominal pain and nausea. PO administration.
Dabigatran: Inhibits thrombin directly preventing fibrinogen from cleaving to fibrin. Different dosing than other DOACs. See slide 25 of provided information.
Bivalirudin: Directly inhibits thrombin. Used mainly in percutaneous coronary interventions (PCI) and patients with heparin-induced thrombocytopenia (HIT). Contraindicated in active bleeding. Side effects include bleeding. Administered intravenously (IV).

Non-Pharmacological Prophylaxis

Ambulation: Important to prevent venous thromboembolism.
Graduated Compression Stockings/Intermittent Pneumatic Compression Devices (IPCD): Improve blood circulation to decrease risk.
Inferior Vena Cava Filters (IVC): Used as a last resort when medical interventions fail in preventing blood clots from reaching the lung.

Heparin-Induced Thrombocytopenia (HIT):

Characterized by thrombocytopenia, timing of platelet fall after heparin therapy, thrombosis, and other causes of thrombocytopenia. Treatment involves stopping heparin therapy and using an alternative anticoagulant.

Other Medications (See Pages 5,6,7 for details)

A variety of other medications are discussed in the provided texts including: ACE inhibitors, Angiotensin II Receptor Blockers (ARBs), Diuretics, Calcium Channel Blockers, Nitrates

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Description

Explore the key aspects of antiplatelet medications including Aspirin, Glycoprotein IIb/IIIa inhibitors, and P2Y12 inhibitors. This quiz covers indications, contraindications, side effects, and administration routes. Test your knowledge on the vital role these drugs play in managing acute coronary syndrome and related conditions.